Community Oncology

Volume 5, Number 11 (November 2008)

Letter from the Editor

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The future has just arrived

Lee S. Schwartzberg, MD, FACP, Editor-in-Chief

The West Clinic, Memphis, TN

A freshly minted administration and brand new Congress are now poised to grapple with the vexing issues of the day. Many feel that President-elect Obama will face the most difficult 4 years in memory, given the huge shadows cast by the economy and the war. But from adversity rises opportunities, and no issue requires creative change more than the way healthcare is delivered in the United States.

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Dr. David Henry discusses this month's issue:

Community Translations

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Gene-expression profiling and cancer of an unknown primary origin

A frequent conundrum encountered by the community oncologist is how to treat a patient with cancer of an unknown primary (CUP). Although 3%–5% of tumors may be classified as CUP, there is no clear consensus on the clinical evaluation or best therapeutic regimen to use in these cases. Described in this article is the molecular test Aviara CancerTYPE ID, which can look for expression of 92 different genes and correlate these expressions with 39 specific cancers and 64 subtypes. The test has about a 90% success rate in identifying the primary tumor.

  

FROM THE COMMUNITY ONCOLOGIST'S PERSPECTIVE
Molecular profiling removes some of the uncertainty of a CUP diagnosis

Patrick Acevedo, MD, MS

Florida Cancer Institute–New Hope, Spring Hill, FL

  

FROM THE ADMINISTRATOR'S PERSPECTIVE
Ordering this test has become routine when unknown primaries are encountered in the clinic

Vicky Castro, CMA

Florida Cancer Institute–New Hope, Spring Hill, FL

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Original Contribution

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Red blood cell transfusion and chemotherapy administration: a study of resource utilization

Leonard Minuk, MD, FRCPC, Ian Chin-Yee, MD, FRCPC, Anita Hibbert, BASc, Daphne Chan, PhD, and Anargyros Xenocostas, MD, FRCPC

Department of Medicine, University of Western Ontario, London, Ontario; London Regional Cancer Program, London Health Sciences Centre, London, Ontario; Canadian Blood Services, London, Ontario; and Medical Affairs, Ortho Biotech Canada, Toronto, Ontario, Canada

Few studies have examined the overall cost and healthcare burden of red blood cell (RBC) transfusion in chemotherapy-induced anemia. The authors analyzed resource utilization by patients receiving RBC transfusion in a tertiary-care cancer center. Transfusion requirements were the most intense and highest among patients with myelodysplastic syndromes/chronic myeloproliferative disorders and nonmalignant hematology patients. Based on prospective chair-time data, an estimated 71,504 minutes were consumed by all RBC transfusions, constituting 5.4% of all outpatient clinic chair-time events. The authors found that RBC transfusion consumed a significant proportion of chair time, which could otherwise have been utilized for chemotherapy administration.

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Review Article

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Updates in the management of esophageal and gastric cancers

Karen E. Bullock, MD, and Johanna C. Bendell, MD

Department of Medicine, Division of Medical Oncology, Duke University Comprehensive Cancer Center, Durham, NC, and Sarah Cannon Research Institute, Nashville, TN

Cancers of the esophagus and stomach continue to be highly lethal malignancies. With a dramatic increase in esophageal adenocarcinomas in Western countries and a continued massive worldwide burden of gastric cancer, new approaches to treatment are vital for these diseases. PET and endoscopic ultrasonography (EUS) have become standard of care in assessing resectability for esophageal cancer. Evidence has emerged that neoadjuvant chemoradiation therapy is beneficial in locally advanced esophageal cancer; however, much effort continues to address whether neoadjuvant chemotherapy alone is comparable. For locally advanced gastric cancer, controversy still ensues between adjuvant versus perioperative chemoradiotherapy and/or chemotherapy. Finally, new chemotherapeutic agents for advanced esophageal and gastric cancers have been under study, most recently the oral fluoropyrimidines, oxaliplatin, and biologic agents.

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Controversies in Patient Care

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Reverse isolation for neutropenic patients

Srividyalakshmi Seshadri, MD, and Michael A. Baumann, MD

Department of Medicine, Division of Hematology/Oncology, Boonshoft School of Medicine, Wright State University, Department of Veterans Affairs, Dayton, OH

Hospital patients with neutropenia are commonly placed in reverse isolation, intended to protect them from acquiring serious infections. This step often causes confusion and anxiety for patients, families, and healthcare workers. The authors reviewed the evidence for efficacy of various types of reverse isolation in select patient groups. Reverse isolation in laminar air flow or high-efficiency particulate air (HEPA)-filtered rooms reduces the incidence of infection and may improve survival for patients receiving allogeneic bone marrow or stem cell grafts. Patients with acute leukemia, aplastic anemia, or other conditions characterized by similarly severe and prolonged neutropenia have also been shown to develop fewer infections when kept in laminar air flow or HEPA-filtered rooms during treatment. However, survival is probably not improved for these patients. Patients receiving chemotherapy for solid tumors or lymphoproliferative diseases who become neutropenic have not been shown to benefit from reverse isolation the way that it is practiced in most hospital settings. The practice should be discouraged in these patients.

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Brief Communications

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Stroke syndrome secondary to hypercoagulability of lung cancer

BoRa Lim, MD, and David H. Henry, MD

Pennsylvania Hospital, Philadelphia, PA

The authors discuss lung cancer complicated by recurrent stroke due to intra-arterial microthrombi formation, which is rarely reported.

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Washington Update

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The President’s Cancer Panel weighs in


Citing a number of worrisome trends, the President’s Cancer Panel issued its 2007–2008 annual report.

  

COMMENTARY
Glossing over a real crisis in cancer care

Ted A. Okon, MBA

Community Oncology Alliance

The Panel missed the real cancer care threat facing Americans: severe cuts to reimbursement ushered in by the Medicare Modernization Act of 2003

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Adverse Events Alert

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Aromatase inhibitors: implications for fractures in perimenopausal women with breast cancer

Beatrice J. Edwards, MD, MPH, Athena Samaras, BA, June M. McKoy, MD, MPH, JD, Simone Boyle, BA, and Charles L. Bennett, MD, PhD, MPP

Health and Osteoporosis Program and Division of Geriatric Medicine, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University; The Robert H. Lurie Comprehensive Cancer Center; VA Midwest Center for Management of Complex Chronic Care; and Jesse Brown VA Medical Center, Chicago, IL

Recent instances of increased fracture risk have been reported among perimenopausal women using aromatase inhibitor treatment.

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© 2008 by Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in writing from the publisher.

The opinions expressed herein are those of the authors or advertisers. The authors, editors, and publishers make every effort to ensure that no inaccurate or misleading data, opinion, or statement is published in this journal and that drug names, dosages, and recommendations are accurate. However, readers should confirm all dosage schedules against the manufacturer’s package information data. The Publisher, Editorial Board, and their employees accept no liability whatsoever for the consequences of any inaccurate or misleading data, opinion, or statement.